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Slouha E, Biput SJ, Krumbach B, Clunes LA, Kollias TF. Transvaginal Laparoscopic Appendectomy: A Systematic Review. Cureus 2024; 16:e51962. [PMID: 38333466 PMCID: PMC10852981 DOI: 10.7759/cureus.51962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 02/10/2024] Open
Abstract
Appendectomy remains the gold standard for treating appendicitis, but advancements in laparoscopic techniques have shifted the paradigm. Natural orifice transluminal endoscopic surgery (NOTES) and transvaginal appendectomy (TVA) offer a potentially less invasive alternative to traditional laparoscopic appendectomy (LA). This article systematically reviews the procedures, perceptions, and complications of TVA to assess its viability as a surgical option. Between January 1, 2003, and November 1, 2023, 4832 case reports, case series, and experimental and observational peer-reviewed publications were examined and filtered using the keyword "Transvaginal Laparoscopic Appendectomy." The publications were screened using PRISMA guidelines, and 20 studies were included for analysis and review. Survey results showed that women's acceptance of TVA was 43%, citing reduced invasiveness as a major reason for positive reception. TVA procedures exhibited consistency, with variations in appendectomy methods, appendix removal, and posterior fornix incision closure. Positive outcomes included shorter operation times, reduced postoperative pain, and minimal scarring. Complications were uncommon but included bladder puncture, urinary tract infections, and intra-abdominal abscesses. Indications primarily focused on surgical safety, reduced scarring, and postoperative benefits. Sexual function post-TVA exhibited no significant differences in most cases, with a recovery period of two to four weeks. This systematic review suggests that TVA is a promising alternative to traditional LA, offering potential advantages in terms of postoperative complications. While the existing literature indicates positive outcomes, further research with larger sample sizes and long-term follow-ups is needed to validate the efficacy and safety of TVA and assess how the procedure impacts the reproductive function of patients.
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Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Stefan J Biput
- Medicine, St George's University School of Medicine, St. George's, GRD
| | - Brandon Krumbach
- Anatomy, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology, and Pharmacology, St. George's University School of Medicine, St. George's, GRD
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2
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Feng D, He L, Li X, Zhang Q, Peng J, Huang L, Liu T, Lin Y. Perioperative outcomes of and predictors for conversion from transvaginal natural orifice transluminal endoscopic tubal surgeries: A retrospective cohort study of 619 patients. Int J Gynaecol Obstet 2023; 161:803-811. [PMID: 36605014 DOI: 10.1002/ijgo.14653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/04/2022] [Accepted: 01/03/2023] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To assess the perioperative outcomes of vNOTES tubal surgeries and to identify predictors of surgical conversion. METHODS A single-center retrospective cohort study was performed on 619 patients who underwent vNOTES tubal surgeries in our institute from December 2018 to October 2021. Patients were categorized into "converted" or "non-converted" groups based on whether conversion occurred. t-test and χ2 test were performed on demographic and clinicopathologic data to compare their perioperative outcomes. Logistic regression was built to identify predictors for surgical conversions. RESULTS The conversion and complication rates of the vNOTES tubal surgeries in the present study were 3.07% and 4.85%, respectively. The "converted group" has a significantly higher percentage of patients with severe pelvic adhesions (9/19 [47.4%]) and pelvic endometriosis (2/19 [10.5%]), which significantly predicates surgical conversion. The "converted group" also had a longer duration of surgery (140.94 ± 88.73 min, P = 0.002) and an increased proportion of "converted from vNOTES" patients experienced more than 50 ml of intraoperative blood loss (7/19 [36.9%]). Four patients had intraoperative rectal injuries, and no Clavien-Dindo III-V postoperative complications occurred. CONCLUSION vNOTES tubal surgeries are safe due to low conversion and complication rates. Severe pelvic adhesion and endometriosis are predictors for surgical conversions.
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Affiliation(s)
- Dan Feng
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Li He
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Xin Li
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qiang Zhang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Jieru Peng
- Medical Administrative Department, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Lu Huang
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Tianjiao Liu
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Yonghong Lin
- Department of Gynecology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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Rudiman R. Minimally invasive gastrointestinal surgery: From past to the future. Ann Med Surg (Lond) 2021; 71:102922. [PMID: 34703585 PMCID: PMC8521242 DOI: 10.1016/j.amsu.2021.102922] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 12/21/2022] Open
Abstract
The improvement of the science and art of surgery began over 150 years ago. Surgical core tasks, “cutting and sewing” with hand and direct contact with the organs, have remained the same. However, in the 21st century, there has been a shifting paradigm in the methodology of surgery. The joint union between innovators, engineers, industry, and patient demands resulted in minimally invasive surgery (MIS). This method has influenced the techniques in every aspect of abdominal surgery, such as surgeons are not required to direct contact or see the structures on which they operate. Advances in the endoscope, imaging, and improved instrumentations convert the essential open surgery into the endoscopic method. Furthermore, computers and robotics show a promising future to facilitate complex procedures, enhance accuracy in microscale operations, and develop a simulation to improve the ability to face sophisticated approaches. MIS has been replacing open surgery due to improved survival, fewer complications, and rapid recoveries in recent years. Minimally invasive surgery's further research in diagnostic and therapeutic modalities is under investigation to achieve genuinely “noninvasive” surgery. Thus, MIS has gained interest in recent days and has been improving with promising outcomes. Minimally invasive surgery has interfered with multiple aspects of the surgical approach. Advancement in the endoscope, imaging, and other instrumentations shifting the current methodological conventional surgery. The benefit over risk is the promising primary outcome to achieve an exceptional quality of life.
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Affiliation(s)
- Reno Rudiman
- Digestive Surgeon, Division of Digestive Surgery, Department of General Surgery, School of Medicine, Padjadjaran University, Hasan Sadikin General Hospital, Bandung, Indonesia
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4
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Thai MT, Phan PT, Hoang TT, Low H, Lovell NH, Do TN. Design, Fabrication, and Hysteresis Modeling of Soft Microtubule Artificial Muscle (SMAM) for Medical Applications. IEEE Robot Autom Lett 2021. [DOI: 10.1109/lra.2021.3072599] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
This work aims to describe the technique and review all transvaginal natural orifice transluminal endoscopic surgery (vNOTES) for adnexal procedures performed and to acknowledge vNOTES as an alternative to conventional laparoscopy. The procedure consisted of an incision in the Pouch of Douglas, insertion of a single port device, laparoscopic surgery through the device, extraction of specimens through the vagina and closure of the vaginal apex with a direct suture. Eighteen procedures have been successfully completed, 1 patient required conversion to conventional abdominal surgery due to intolerance to pneumoperitoneum. Surgeries' length range was 45-210 minutes. The estimated blood loss was less than 100 mL. The patients required minimal analgesia, were discharged the day after and had no postoperative complications. No patients complained of dyspareunia. Two patients conceived after surgery. vNOTES is a safe and desirable approach to the adnexa and a reasonable alternative to conventional laparoscopy or vaginal surgery.Impact statementWhat is already known on this subject? Natural Orifice Transluminal Surgery (NOTES) is a technique used to access the abdominal cavity through natural orifice. Compared to conventional laparoscopy, it's expected to have fewer complications.What do the results of this study add? This is one of the few works addressing vNOTES adnexal surgery, which appears to be a good alternative to conventional laparoscopy.What are the implications of these findings for clinical practice and/or further research? vNOTES may be a desirable approach to the adnexa. This work opens a door to new research regarding vNOTES in more complex gynaecologic procedures.
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Affiliation(s)
- Pedro Brandão
- Department of Reproductive Medicine, Instituto Valenciano de Infertilidad Plaza de la Policia Local 3, Valencia, Spain.,Faculdade de Medicina da Universidade do Porto Alameda Hernani Monteiro, Porto, Portugal
| | - Amélia Almeida
- Department of Obstetrics and Gynaecology, Centro Hospitalar Médio Ave Rua Artur Cupertino Miranda 150, Vila Nova de Famalicão, Portugal
| | - Paula Ramôa
- Department of Gynaecologic Endoscopy, Hospital Lusíadas Porto Av. da Boavista 171, Porto, Portugal
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6
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Lei Y, Li Y, Song R, Du F. Development of a novel deployable arm for natural orifice transluminal endoscopic surgery. Int J Med Robot 2021; 17:e2232. [PMID: 33480095 DOI: 10.1002/rcs.2232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/13/2021] [Accepted: 01/15/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) is aided by the instrument channel of an endoscope. Limited by the diameter of the endoscope, the construction of the operation triangle is affected. This paper presents a deployable arm that can increase the distance between the arms. METHODS The manipulation arm is composed of a continuum arm and a deployable arm. The deployable arm can be locked by a stay cable and a mechanical structure. The angle between the end-effectors and the common workspace of the two manipulation arms are comprehensively analysed. Through experiments, the design parameters are validated and justified. RESULTS The experiment shows that the deployment arm can maintain the deformation within 3.5 mm under a 300 g load, and the angle between the two end-effectors can be maintained within the range of [88°, 110°]. CONCLUSIONS The novel deployment arms enlarge the angle between the end effectors, which significantly improves the flexibility of the arms.
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Affiliation(s)
- Yanqiang Lei
- School of Control Science and Engineering, Shandong University, Jinan, China.,Engineering Research Center of Intelligent Unmanned System, Ministry of Education, Jinan, China
| | - Yibin Li
- School of Control Science and Engineering, Shandong University, Jinan, China.,Engineering Research Center of Intelligent Unmanned System, Ministry of Education, Jinan, China
| | - Rui Song
- School of Control Science and Engineering, Shandong University, Jinan, China.,Engineering Research Center of Intelligent Unmanned System, Ministry of Education, Jinan, China
| | - Fuxin Du
- School of Control Science and Engineering, Shandong University, Jinan, China.,Engineering Research Center of Intelligent Unmanned System, Ministry of Education, Jinan, China.,School of Mechanical Engineering, Shandong University, Jinan, China
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7
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Jategaonkar PA, Yadav SP, Gupta D. Transvaginal laparoscopic appendectomy using innovative submucosal tunnels: a conducive modification for improving hybrid NOTES access and its critical appraisal. Trop Doct 2020; 50:209-215. [DOI: 10.1177/0049475520921277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Currently, transvaginal natural orifice transluminal endoscopic surgery (NOTES), the most minimally invasive option for laparoscopic surgery, suffers various technological restraints limiting its implementation. We discuss a simple modification for vaginal access to improve the existing hybrid NOTES technique. We retrospectively studied 18 women at our rural hospital in central India, who, under defined criteria, underwent transvaginal appendicectomy using innovative strategically designed submucosal tunnels. The procedure was successfully completed in all but the first three cases. None required additional abdominal trocar or analgesia beyond the first 6 h. The mean operative and hospitalisation times were 27.5 min and 18.5 h, respectively. We had no intraoperative complications and only one patient experienced postoperative self-limiting vaginal spotting. All patients were very pleased with the cosmetic results and sexual life as assessed by locally devised scales. On regular follow-up, all were progressing well. We recommend the method presented, as it is not only feasible and safe but has the potential to improve overall results. Clearly, a larger volume randomised trial would be optimal to confirm our conclusion.
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Affiliation(s)
- Priyadarshan A Jategaonkar
- Professor of Surgery, Surgical Gastroenterologist and Advance Laparoscopic Surgeon, Department of Surgery, Division of GI & Minimal Access Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
| | - Sudeep P Yadav
- Senior Resident, Department of Plastic & Reconstructive Surgery, Grant’s Government Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Dilip Gupta
- Director, Professor and Head, Department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India
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Xu W, Xu Z, Cheng H, Ying J, Cheng F, Xu W, Cao J, Luo J. Comparison of short-term clinical outcomes between transanal and laparoscopic total mesorectal excision for the treatment of mid and low rectal cancer: A meta-analysis. Eur J Surg Oncol 2016; 42:1841-1850. [PMID: 27697315 DOI: 10.1016/j.ejso.2016.09.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/05/2016] [Indexed: 02/07/2023] Open
Abstract
AIM The objective of this meta-analysis was to evaluate the feasibility, safety, and short-term clinical outcomes of transanal total mesorectal excision (TaTME) comparing with laparoscopy total mesorectal excision (LapTME) for mid and low rectal cancer. METHODS Relevant studies were searched from the databases of Pubmed, Embase, and the Cochrane Library. The qualities of all of the included studies were evaluated using Newcastle-Ottawa Scale (NOS). The synthesized outcomes were pooled using fixed-effects models or random-effects models, which weighted the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (95% CI). A funnel plot was used to evaluate the publication bias. RESULTS Seven original studies including 209 TaTME patients and 257 LapTME patients with rectal cancer met the inclusion criteria in this meta-analysis. Compared with LapTME, TaTME showed a longer CRM, lower rate of positive CRM, complete TME rate, and less operative time. There were no significant differences in the outcomes of the harvested lymph nodes, distal margin distance, hospital stay, intraoperative complications, anastomotic leakage, postoperative complications, reoperation, readmission, or conversion between the TaTME group and the LapTME group. CONCLUSIONS Compared with LapTME, TaTME is a feasible and safe approach for patients with mid and low rectal cancer. In addition, TaTME showed a better short-term clinical outcomes, such as a longer CRM, lower risk of positive CRM, higher complete quality of TME rate, and shorter operative duration. Further prospective studies with long-term follow-up are required.
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Affiliation(s)
- W Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - Z Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - H Cheng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - J Ying
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - F Cheng
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - W Xu
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - J Cao
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China
| | - J Luo
- Department of General Surgery, The Second Affiliated Hospital of Nanchang University, 330006, Nanchang, Jiangxi, China.
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9
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Chouillard E, Regnier A, Vitte RL, Bonnet BV, Greco V, Chahine E, Daher R, Biagini J. Transanal NOTES total mesorectal excision (TME) in patients with rectal cancer: Is anatomy better preserved? Tech Coloproctol 2016; 20:537-44. [DOI: 10.1007/s10151-016-1449-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 01/27/2023]
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10
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Carniel EL, Mencattelli M, Bonsignori G, Fontanella CG, Frigo A, Rubini A, Stefanini C, Natali AN. Analysis of the structural behaviour of colonic segments by inflation tests: Experimental activity and physio-mechanical model. Proc Inst Mech Eng H 2015; 229:794-803. [PMID: 26396226 DOI: 10.1177/0954411915606484] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 08/25/2015] [Indexed: 12/19/2022]
Abstract
A coupled experimental and computational approach is provided for the identification of the structural behaviour of gastrointestinal regions, accounting for both elastic and visco-elastic properties. The developed procedure is applied to characterize the mechanics of gastrointestinal samples from pig colons. Experimental data about the structural behaviour of colonic segments are provided by inflation tests. Different inflation processes are performed according to progressively increasing top pressure conditions. Each inflation test consists of an air in-flow, according to an almost constant increasing pressure rate, such as 3.5 mmHg/s, up to a prescribed top pressure, which is held constant for about 300 s to allow the development of creep phenomena. Different tests are interspersed by 600 s of rest to allow the recovery of the tissues' mechanical condition. Data from structural tests are post-processed by a physio-mechanical model in order to identify the mechanical parameters that interpret both the non-linear elastic behaviour of the sample, as the instantaneous pressure-stretch trend, and the time-dependent response, as the stretch increase during the creep processes. The parameters are identified by minimizing the discrepancy between experimental and model results. Different sets of parameters are evaluated for different specimens from different pigs. A statistical analysis is performed to evaluate the distribution of the parameters and to assess the reliability of the experimental and computational activities.
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Affiliation(s)
- Emanuele L Carniel
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | | | | | | | - Alessandro Frigo
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Alessandro Rubini
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy Department of Biomedical Sciences, University of Padova, Padova, Italy
| | - Cesare Stefanini
- The BioRobotics Institute, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Arturo N Natali
- Department of Industrial Engineering, Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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11
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Kim MJ, Park JW, Ha HK, Jeon BG, Shin R, Ryoo SB, Choi SJ, Park BK, Park KJ, Jeong SY. Initial experience of transanal total mesorectal excision with rigid or flexible transanal platforms in cadavers. Surg Endosc 2015; 30:1640-7. [PMID: 26169645 DOI: 10.1007/s00464-015-4398-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 06/28/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Transanal total mesorectal excision (taTME) is expected to provide benefits in the removal of the complete mesorectum for low rectal lesions, and several clinical studies regarding this technique have been reported. However, a transanal platform has not yet been standardized, and diverse transanal endoluminal surgery access devices have been used, based on individual surgeon preferences. In the present study, we performed laparoscopy-assisted taTME in cadavers and compared the characteristics of four different platforms. METHODS Between January 2013 and April 2015, laparoscopy-assisted taTME was performed on six fresh cadavers. Flexible [SILS™ Port (Covidien), GelPOINT(®) Path Transanal Access Platform (Applied Medical)] and rigid [TEO(®) (Karl Storz Endoskope), TEM (Richard Wolf)] transanal access platforms were used on three cadavers each. RESULTS All cadavers were male, with a mean age of 69.2 (range 57-86) years. The mean operation time was 146.3 (range 140-155) min with flexible platforms and 206.7 (range 150-260) min with rigid platforms. The mean specimen length was 23 (range 18-26) cm. Complete or nearly complete mesorectal specimens were obtained in all cases, except for one case using the TEM platform. Flexible platforms (SILS and GelPOINT) provided a short set-up time, relatively atraumatic retraction, and easy application of familiar laparoscopic instruments; a narrow operative field was its limitation. The rigid platforms (TEO and TEM) enabled larger and more stable operative fields and space than did the SILS platform, but they were limited by a narrow view, prolonged set-up time, rigidity, and long channels relative to the short distance from the anus to the rectal closure site. CONCLUSION In this preliminary study, laparoscopy-assisted taTME was a feasible and safe procedure using both rigid and soft platforms, despite some limitations of each platform.
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Affiliation(s)
- Min Jung Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Heon-Kyun Ha
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Byeong Geon Jeon
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Rumi Shin
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-ji Choi
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Byung Kwan Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
- Cancer Research Institute, Seoul National University, Seoul, Korea.
- Colorectal Cancer Center, Seoul National University Cancer Hospital, Seoul, Korea.
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12
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Duarte RM, Ferreira NV, Oliveira AM, Fonseca FP, Vieira-Silva M, Correia-Pinto J. Benefits of radial distortion correction in arthroscopic surgery: a first experimental study on a knee model. Int J Med Robot 2014; 11:341-347. [PMID: 25242547 DOI: 10.1002/rcs.1612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 07/26/2014] [Accepted: 07/28/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lens probes used in arthroscopy typically have a small diameter and wide field-of-view. This introduces strong radial distortion (RD) into the image, ultimately affecting the surgeon's hand-eye coordination. This study evaluates potential benefits of using distortion-free images in arthroscopic surgery. METHODS Distortion-free images were obtained using RDFixer™ software (Perceive3D, SA) to remove RD in the input video stream. Twelve orthopedic residents performed an arthroscopic task (loose body removal) in a dry-knee model using video with and without distortion. Residents were questioned about image quality, and surgical performance was rated using an adapted Global Rating Scale. RESULTS A statistically significant improvement of all parameters was observed with distortion-free images. Residents perceived distortion-free images as providing a wider field-of-view and a better notion of relative depth and distance. CONCLUSION RD correction improved the surgical performance of residents, potentially decreasing their learning curve. Future work will study whether the benefits are observable in experienced surgeons. Copyright © 2014 John Wiley & Sons, Ltd.
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Affiliation(s)
- Rui M Duarte
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho.,ICVS/3B's PT Government Associate Laboratory.,Orthopedic Surgery Department, Hospital de Braga
| | - Nuno V Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho.,ICVS/3B's PT Government Associate Laboratory.,Orthopedic Surgery Department, Hospital de Braga
| | - Armando M Oliveira
- University of Coimbra, Institute of Cognitive Psychology - Faculty of Psychology and Educational Sciences
| | - Fernando P Fonseca
- Orthopedic Surgery Department, Centro Hospitalar da Universidade de Coimbra.,Medical School, University of Coimbra
| | - Manuel Vieira-Silva
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho.,ICVS/3B's PT Government Associate Laboratory.,Orthopedic Surgery Department, Hospital de Braga
| | - Jorge Correia-Pinto
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho.,ICVS/3B's PT Government Associate Laboratory.,Pediatric Surgery Department, Hospital de Braga
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13
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Ahmed MU, Aftab A, Seriwala HM, Khan AM, Anis K, Ahmed I, Rehman SU. Can single incision laproscopic cholecystectomy replace the traditional four port laproscopic approach: a review. Glob J Health Sci 2014; 6:119-25. [PMID: 25363123 PMCID: PMC4825526 DOI: 10.5539/gjhs.v6n6p119] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/03/2014] [Indexed: 12/25/2022] Open
Abstract
The major aim of surgeons has always been a minimalist approach towards surgery, thereby reducing the complications associated with the surgery. The gold standard treatment for cholelithiasis with cholecystitis is currently the four port laparoscopic cholecystectomy (4 PLC). Recently, a newer technique has been introduced which uses a single port, rather than the four ports, for the removal of the gall bladder laparoscopically; it is known as Single Incision Laparoscopic Cholecystectomy (SILC). This is a comparatively minimal approach towards surgery. Therefore the purpose of this review is to compare the advantages and the disadvantages of SILC versus 4PLC, and hence, to give an idea of whether SILC is ready to replace the traditional approach as the new treatment of choice.
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14
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Chouillard E, Chahine E, Khoury G, Vinson-Bonnet B, Gumbs A, Azoulay D, Abdalla E. NOTES total mesorectal excision (TME) for patients with rectal neoplasia: a preliminary experience. Surg Endosc 2014; 28:3150-7. [PMID: 24879139 DOI: 10.1007/s00464-014-3573-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 04/17/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopy are emerging, minimally invasive techniques. Total mesorectal excision (TME), the gold standard treatment for patients with resectable distal rectal tumors, is usually performed in an "up-to-down" approach, either laparoscopically or via open techniques. A transanal, "down-to-up" TME has already been reported. Our NOTES variant of TME (NOTESTME) is based on a transperineal approach without any form of abdominal assistance. The aim was to reduce further the invasiveness of the procedure while optimizing the anatomical definition of the distal mesorectum. This approach may lead to reduced postoperative pain, decreased hernia formation and improved cosmesis when compared to standard laparoscopy. METHODS NOTESTME was attempted in 16 patients with distal rectal neoplasia (i.e., distal edge of the tumor lower than the pouch of Douglas, between 0 and 12 cm from the dentate line). Additional inclusion criteria consisted of an ASA status ≤III and the absence of previous abdominal surgery. RESULTS NOTESTME was completed in all patients. Additional abdominal, single-incision laparoscopic assistance was required in 6 (38 %) patients. Mean operative time was 265 min (range 155-440 min). The morbidity rate was 18.8 % (two small bowel obstructions and one pelvic abscess), requiring re-operation in each case. No leaks occurred, and the mortality rate at 30 and 90 days was 0 %. Resection margins were negative in all patients. A median of 17 nodes (range 12-81) was retrieved per specimen. Mean length of hospital stay was 10 days (range 4-29 days). Patients were followed for an average of 7 months (range 3-23 months). CONCLUSION NOTESTME was feasible and safe in this series of patients with mid- or low rectal tumors. The short-term mortality and morbidity rates are acceptable, with no apparent compromise in the oncological quality of the resection. Larger, randomized controlled trials with long-term follow-up are warranted.
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Affiliation(s)
- E Chouillard
- Division of Colon and Rectal Surgery, Department of Surgery, Centre Hospitalier Poissy/Saint-Germain-en-Laye, 10 rue du Champ Gaillard, 78300, Poissy, France,
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15
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Emhoff IA, Lee GC, Sylla P. Transanal colorectal resection using natural orifice translumenal endoscopic surgery (NOTES). Dig Endosc 2014; 26 Suppl 1:29-42. [PMID: 24033375 DOI: 10.1111/den.12157] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/08/2013] [Indexed: 02/08/2023]
Abstract
The surgical management of rectal cancer has evolved over the past century, with total mesorectal excision (TME) emerging as standard of care. As a result of the morbidity associated with open TME, minimally invasive techniques have become popular. Natural orifice translumenal endoscopic surgery (NOTES) has been held as the next revolution in surgical techniques, offering the possibility of 'incisionless' TME. Early clinical series of transanal TME with laparoscopic assistance (n = 72) are promising, with overall intraoperative and postoperative complication rates of 8.3% and 27.8%, respectively, similar to laparoscopic TME. The mesorectal specimen was intact in all patients, and 94.4% had negative margins. There was no oncological recurrence in average-risk patients at short-term follow up, and 2-year survival rates in high-risk patients were comparable to that after laparoscopic TME. These preliminary studies demonstrate transanal NOTES TME with laparoscopic assistance to be clinically feasible and safe given careful patient selection, surgical expertise, and appropriate procedural training. We are hopeful that with optimization of transanal instruments and surgical techniques, pure transanal NOTES TME will become a viable alternative to open and laparoscopic TME in the future.
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Affiliation(s)
- Isha Ann Emhoff
- Department of Surgery, Division of Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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16
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Rolanda C, Caetano AC, Dinis-Ribeiro M. Emergencies after endoscopic procedures. Best Pract Res Clin Gastroenterol 2013; 27:783-98. [PMID: 24160934 DOI: 10.1016/j.bpg.2013.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 02/08/2023]
Abstract
Endoscopy adverse events (AEs), or complications, are a rising concern on the quality of endoscopic care, given the technical advances and the crescent complexity of therapeutic procedures, over the entire gastrointestinal and bilio-pancreatic tract. In a small percentage, not established, there can be real emergency conditions, as perforation, severe bleeding, embolization or infection. Distinct variables interfere in its occurrence, although, the awareness of the operator for their potential, early recognition, and local organized facilities for immediate handling, makes all the difference in the subsequent outcome. This review outlines general AEs' frequencies, important predisposing factors and putative prophylactic measures for specific procedures (from conventional endoscopy to endoscopic cholangio-pancreatography and ultrasonography), with comprehensive approaches to the management of emergent bleeding and perforation.
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Affiliation(s)
- Carla Rolanda
- Department of Gastroenterology, Hospital Braga, Braga, Portugal; Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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17
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Gao J, Li P, Li Q, Tang D, Wang DR. Comparison between single-incision and conventional three-port laparoscopic appendectomy: a meta-analysis from eight RCTs. Int J Colorectal Dis 2013; 28:1319-27. [PMID: 23728596 DOI: 10.1007/s00384-013-1726-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the efficacy and safety of single-incision laparoscopic appendectomy (SILA), we conducted a meta-analysis of randomized controlled trials (RCTs) comparing conventional three-port laparoscopic appendectomy (CTLA). METHODS RCTs comparing the effects of SILA and CTLA were searched for in PubMed, the Cochrane Central Register of Controlled Trials, and Embase. Operative time, the pain visual analogue scales scores (VAS scores), dose of analgesics, postoperative complications, hospital charges, and duration of postoperative hospitalization in SILA and CTLA were pooled and compared by meta-analysis. Odds ratios and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs) to evaluate the effect of SILA. RESULT Eight original RCTs investigating 760 adults and 684 children, 1,444 patients in total, of whom 721 received SILA only and 723 received CTLA only, met the inclusion criteria. Both in adults and children, the mean operative time was significantly longer in SILA than CTLA (WMD5.45, 95% CI 2.15 to 8.75, p = 0.01). Compared with CTLA, in children, SILA have higher analgesic consumption (WMD 0.69, 95% CI 0.08 to 1.3, p = 0.03) and greater hospital charges (WMD 0.87, 95% CI 1.26 to 1.48, p = 0.005), which was not statistically different in adults (p > 0.05). Pooling the results for SILA and CTLA revealed no significant difference in VAS scores, wound infection rate, overall complications, and postoperative hospital stay. CONCLUSION SILA failed to show any obvious advantages over CTLA in perioperative and postoperative outcomes. Therefore, it represents a possible alternative to conventional three-port laparoscopic appendectomy.
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Affiliation(s)
- Jun Gao
- Department of Gastrointestinal Surgery, Subei People's Hospital of Jiangsu Province (Clinical Medical College of Yangzhou University), 98 Nantong West Road, Yangzhou, Jiangsu Province, People's Republic of China
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18
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Abstract
Single-incision laparoscopic ventral hernia repair appears to offer a virtually scarless methodology for this procedure. Introduction: Although natural orifice transluminal endoscopic surgery promises truly scarless surgery, this has not progressed beyond the experimental setting and a few clinical cases in the field of ventral hernia repair. This is mainly because of the problem of sterilizing natural orifices, which prevents the use of any prosthetic material because of unacceptable risks of infection. Single-incision laparoscopic ventral hernia repair has gained more widespread acceptance by specialized hernia centers. Even so, there is a special subset of patients who are young and/or scar conscious and find any visible scar unacceptable. This study illustrates an innovative way of performing single-incision laparoscopic ventral hernia repair by a transverse suprapubic incision below the pubic hair/bikini line in 2 young male patients who had both umbilical and epigastric hernias as well as attenuated linea alba in the upper abdomen. Case Description: Both patients underwent successful laparoscopic repair, and both were highly satisfied with the procedure, which produced no visible scars on their abdomen. Discussion: Willingness to adopt new innovative procedures, such as single-incision laparoscopic surgery, has allowed modification of the incision site to produce invisible scars and hence become highly attractive to the young and scar-phobic segment of the population.
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Affiliation(s)
- Hanh Tran
- Discipline of Surgery, University of Sydney, Westmead NSW, Australia
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Carniel EL, Gramigna V, Fontanella CG, Stefanini C, Natali AN. Constitutive formulations for the mechanical investigation of colonic tissues. J Biomed Mater Res A 2013; 102:1243-54. [PMID: 23650076 DOI: 10.1002/jbm.a.34787] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/30/2013] [Accepted: 05/01/2013] [Indexed: 12/19/2022]
Abstract
A constitutive framework is provided for the characterization of the mechanical behavior of colonic tissues, as a fundamental tool for the development of numerical models of the colonic structures. The constitutive analysis is performed by a multidisciplinary approach that requires the cooperation between experimental and computational competences. The preliminary investigation pertains to the review of the tissues histology. The complex structural configuration of the tissues and the specific distributions of fibrous elements entail the nonlinear mechanical behavior and the anisotropic response. The identification of the mechanical properties requires to perform mechanical tests according to different loading situations, as different loading directions. Because of the typical functionality of colon structures, the tissues mechanics is investigated by tensile tests, which are performed on taenia coli and haustra specimens from fresh pig colons. Accounting for the histological investigation and the results from the mechanical tests, a specific hyperelastic framework is provided within the theory of fiber-reinforced composite materials. Preliminary analytical formulations are defined to identify the constitutive parameters by the inverse analysis of the experimental tests. Finite element models of the specimens are developed accounting for the actual configuration of the colon structures to verify the quality of the results. The good agreement between experimental and numerical model results suggests the reliability of the constitutive formulations and parameters. Finally, the developed constitutive analysis makes it possible to identify the mechanical behavior and properties of the different colonic tissues.
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Affiliation(s)
- Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy; Centre of Mechanics of Biological Materials, University of Padova, Padova, Italy
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Kye BH, Lee J, Kim W, Kim D, Lee D. Comparative study between single-incision and three-port laparoscopic appendectomy: a prospective randomized trial. J Laparoendosc Adv Surg Tech A 2013; 23:431-6. [PMID: 23473061 DOI: 10.1089/lap.2012.0284] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Single-incision laparoscopic surgery is a new procedure used to treat a variety of diseases requiring surgical intervention. The aim of this prospective comparative study is to compare the technical feasibility and safety of single-incision and three-port laparoscopic appendectomy. STUDY DESIGN Between February 2009 and April 2010, 102 patients with appendicitis were enrolled in this study. The patients were randomly assigned to two groups: single-incision or three-port laparoscopic appendectomy. Patients with perforated appendicitis were not excluded. We analyzed the patients' clinical characteristics and surgical outcomes. RESULTS There were no significant differences in preoperative patient demographics between the two groups with respect to body mass index (22.03±4.07 kg/m(2) in the single-incision group versus 21.97±3.49 kg/m(2) in the three-port group, P=.930). The pain score on the visual analog scale on postoperative Day 1 was significantly lower in the single-incision group than in the three-port group (3.22±1.22 versus 3.90±1.46, P=.012). Additionally, recovery time to daily life was significantly shorter in the single-incision group than in the three-port group (3.22±1.04 versus 3.94±1.43 days, P=.005). In patients with perforated appendicitis, the single-incision procedure took approximately 10 minutes less than the three-port procedure (44.11±7.75 versus 54.14±32.21 minutes, P=.449), and the postoperative hospital stay (P=.033) and recovery time to daily life (P=.001) were significantly shorter in the single-incision group. CONCLUSIONS Single-incision laparoscopic appendectomy is a feasible and safe procedure, even in patients with perforated appendicitis, and this procedure is even less invasive than three-port laparoscopic surgical techniques.
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Affiliation(s)
- Bong-Hyeon Kye
- Department of Surgery, School of Medicine, The Catholic University of Korea, Seoul, Korea
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NOTES: Interdisciplinary battleground of the future? Surg Laparosc Endosc Percutan Tech 2012; 22:477; author reply 477-8. [PMID: 23047397 DOI: 10.1097/sle.0b013e318267cadd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lamas-Pinheiro R, Henriques-Coelho T, Carvalho JL, Correia-Pinto J. Duhamel pull-through assisted by transrectal port: a hybrid natural orifice transluminal endoscopic surgery approach. J Pediatr Surg 2012; 47:1962-5. [PMID: 23084218 DOI: 10.1016/j.jpedsurg.2012.05.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/09/2012] [Accepted: 05/24/2012] [Indexed: 11/15/2022]
Abstract
One of the latest surgical innovations is natural orifice transluminal endoscopic surgery (NOTES). We hypothesize that the principles of NOTES could be applied to the laparoscopic Duhamel procedure. Between March 2008 and May 2010, 3 children underwent the laparoscopic Duhamel procedure assisted by transrectal NOTES. Three 5-mm transabdominal trocars were combined with a 12-mm transrectal trocar. We were able to safely apply the principles of NOTES, improving the performance of laparoscopic Duhamel pull-through using current instruments and technology. This new approach avoids the need of an extra transabdominal 12-mm trocar for the endoscopic stapler, allows an easier creation of a smaller rectal stump, and offers the possibility of an extra working port. This hybrid concept can be seen as a transition into the emerging field of NOTES in colorectal surgery.
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Abstract
The pedagogical approach to surgical training has changed significantly over the past few decades. No longer are surgical skills solely acquired through a traditional apprenticeship model of training. The acquisition of many technical and nontechnical skills is moving from the operating room to the surgical skills laboratory through the use of simulation. Many platforms exist for the learning and assessment of surgical skills. In this article, the authors provide a broad overview of some of the currently available surgical simulation modalities including bench-top models, laparoscopic simulators, simulation for new surgical technologies, and simulation for nontechnical surgical skills.
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Affiliation(s)
| | - Helen MacRae
- Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, Ontario, Canada
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Kumar V, Dadhwal US. Cholecystectomy: What's new? Med J Armed Forces India 2012; 68:288-92. [PMID: 24532890 DOI: 10.1016/j.mjafi.2012.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Vipon Kumar
- Associate Professor, Department of Surgery, AFMC, Pune 40, India
| | - U S Dadhwal
- Associate Professor, Department of Surgery, AFMC, Pune 40, India
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Natural orifice translumenal endoscopic surgery in humans: a review. Minim Invasive Surg 2012; 2012:189296. [PMID: 22720153 PMCID: PMC3375094 DOI: 10.1155/2012/189296] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 03/06/2012] [Indexed: 12/21/2022] Open
Abstract
Natural orifice translumenal endoscopic surgery (NOTES) had its origins in numerous small animal studies primarily examining safety and feasibility. In human trials, safety and feasibility remain at the forefront; however, additional logistic, practical, and regulatory requirements must be addressed. The purpose of this paper is to evaluate and summarize published studies to date of NOTES in humans. The literature review was performed using PUBMED and MEDLINE databases. Articles published in human populations between 2007 and 2011 were evaluated. A review of this time period resulted in 48 studies describing procedures in 916 patients. Transcolonic and transvesicular procedures were excluded. The most common procedure was cholecystectomy (682, 75%). The most common approach was transvaginal (721, 79%). 424 procedures (46%) were pure NOTES and 491 (54%) were hybrid NOTES cases. 127 (14%) were performed in the United States of America and 789 (86%) were performed internationally. Since 2007, there has been major development in NOTES in human populations. A preponderance of published NOTES procedures were performed internationally. With further development, NOTES may make less invasive surgery available to a larger human population.
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Single-incision laparoscopic cholecystectomy: is it a plausible alternative to the traditional four-port laparoscopic approach? Minim Invasive Surg 2012; 2012:347607. [PMID: 22649722 PMCID: PMC3357560 DOI: 10.1155/2012/347607] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2011] [Accepted: 02/23/2012] [Indexed: 12/16/2022] Open
Abstract
The current standard-of-care for treatment of cholecystectomy is the four port laparoscopic approach. The development of single incision/laparoendoscopic single site surgery (SILC/LESS) has now led to the development of new techniques for removal of the gallbladder. The use of SILC/LESS is now currently being evaluated as the next step in treatment of cholecystectomy. This review is an attempt to consolidate the current knowledge and analyze the feasibility of world-wide implementation of SILC/LESS.
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Natural orifice transesophageal endoscopic surgery: state of the art. Minim Invasive Surg 2012; 2012:896952. [PMID: 22567228 PMCID: PMC3337494 DOI: 10.1155/2012/896952] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Accepted: 02/09/2012] [Indexed: 12/21/2022] Open
Abstract
The main goal of Natural Orifice Transluminal Endoscopic Surgery (NOTES) is performing surgery avoiding skin incisions. Theoretical advantages of NOTES include decreased postoperative pain, reduction/elimination of general anesthesia, improved cosmetic outcomes, elimination of skin incision-related complications such as wound infections and hernias, and increased overall patient satisfaction. Although various forms of port creation to accomplish thoracic NOTES procedures have been proposed, transesophageal NOTES has been shown to be the most reliable one. The evolution of endoscopic submucosal transesophageal access resulted in the development of per-oral endoscopic myotomy (POEM), which had a fast transition to clinical practice. The authors present a review of the current state of the art concerning transesophageal NOTES, looking at its potential for diagnostic and therapeutic interventions as well as the hurdles yet to be overcome.
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Khanna A. Commentary on "Are natural orifice transluminal endoscopic surgery and single-incision surgery viable techniques for cholecystectomy?". J Laparoendosc Adv Surg Tech A 2012; 22:15-6. [PMID: 22296592 DOI: 10.1089/lap.2012.9999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ajai Khanna
- Division of Transplantation & Hepatobiliary Surgery, University of California, San Diego, San Diego, California, USA.
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